Table.
GRADE evaluation of interventions for tubal ectopic pregnancy
| Important outcomes | Treatment failure, primary treatment success, subsequent pregnancies, mortality, adverse effects | ||||||||
| Number of studies (participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What treatments improve outcomes in women with unruptured tubal ectopic pregnancy? | |||||||||
| 2 studies (440) | Treatment failure | Salpingectomy v salpingotomy | 2 | –1 | 0 | 0 | 0 | Very low | Quality point deducted for incomplete reporting of results |
| 2 studies (214) | Treatment failure | Salpingectomy v methotrexate | 2 | –1 | 0 | 0 | 0 | Very low | Quality point deducted for incomplete reporting of results |
| 2 studies (298) | Treatment failure | Salpingotomy v methotrexate | 2 | –1 | 0 | 0 | 0 | Very low | Quality point deducted for incomplete reporting of results |
| 3 studies (1907) | Subsequent pregnancy rates | Salpingectomy v salpingotomy | 2 | –1 | –1 | 0 | 0 | Very low | Quality point deducted for incomplete reporting of results. Consistency point deducted for conflicting results |
| 12 studies (2300) | Recurrent ectopic pregnancy rates | Salpingectomy v salpingotomy | 2 | –1 | –1 | 0 | 0 | Very low | Quality point deducted for incomplete reporting of results. Consistency point deducted for conflicting results |
| 1 study (116) | Treatment failure | Methotrexate plus surgery v surgery alone | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 4 RCTs and 23 studies (1435) | Treatment failure | Single-dose methotrexate v multiple-dose regimens | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for incomplete reporting of results and uncertainty about quality of studies |
| 1 SR included 4 RCTs (265) | Primary treatment success | Single-dose methotrexate v salpingotomy | 4 | 0 | 0 | 0 | 0 | High | |
| 1 SR included 2 RCTs (174) | Primary treatment success | Multiple-dose methotrexate v salpingotomy | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 SR and 3 RCTs (115) | Subsequent pregnancy rates | Single-dose methotrexate v salpingotomy | 4 | 0 | 0 | 0 | 0 | High | |
| 1 SR and 1 RCT (74) | Subsequent pregnancy rates | Multiple-dose methotrexate v salpingotomy | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 2 studies (232) | Subsequent pregnancy rates | Expectant management v surgery | 2 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for differences in inclusion criteria |
| 1 SR and 2 RCTs (165) | Treatment failure | Laparoscopy (salpingotomy) v laparotomy (salpingotomy) | 4 | 0 | 0 | 0 | 0 | High | |
| 1 SR and 2 RCTs (127) | Subsequent pregnancy rates | Laparoscopy v laparotomy | 4 | 0 | 0 | 0 | 0 | High | |
| 2 studies (291) | Treatment failure | Methotrexate plus mifepristone v methotrexate | 4 | 0 | 0 | 0 | 0 | High |
SR, systematic review. Type of evidence: 4 = RCT; 2 = Observational. Consistency: similarity of results across studies Directness: generalisability of population or outcomesEffect size: based on relative risk or odds ratio